Attention deficit hyperactivity disorder (ADHD) is the most common mental health disorder of childhood, affecting as many as 3-17 percent of children and adolescents in the United States. Services families of mentally ill children need most are intensive in-home mental health and support services and case-management. While the potential negative effects of ADHD on family function are clear and family based interventions have consistently been reported as being efficacious in families with children with externalizing problems, few family-based studies have been conducted to support families with ADHD children. To begin to address this gap in clinical practice the overall aim of this study is to test a home-based nurse case-management intervention, called PACT: Parents and Children Together, designed to provide intensive in-home services to advocate for the needs of families with children with ADHD. The specific aims of this study are to: 1) evaluate the efficacy of PACT for families with children and adolescents with ADHD and determine if the intervention, compared to the control condition, reduces maternal distress, improves family functioning, and impacts child behavior problems 2) explore whether treatment is differentially efficacious depending on the ethnic group, and 3) describe participant perceptions of the intervention. The proposed project is aimed at improving family outcomes for families with children with ADHD by demonstrating the efficacy of a nurse case-management intervention. The overall long-term goals of this program of research are to develop, refine and test culturally sensitive and relevant family-based interventions for families with children with ADHD, and eventually, for families with children with other disruptive behavioral disorders in order to help ameliorate the difficulties they experience. Data will be collected primarily from mothers and ADHD children age 12 and over (with all family members encouraged to participate in both the intervention and data collection efforts), and teachers, using both quantitative and qualitative measures. The sample will include 150 families with children with ADHD (75 in the intervention group and 75 in the control group). Because ethnic minorities bear a greater disability burden from unmet mental health needs relative to whites, efforts will be made to over-sample both Hispanic and African American families so that the final sample will include at least 20% African American and 20% Hispanic families (30 families in each ethnic group). This is a beginning proposal to test the efficacy of a nurse case-management intervention and to determine if the trajectories of child behavior problems, maternal distress, and family functioning differ across ethnic groups from baseline to 18 months.